| NPI | 1780946756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 56543) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 56543) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2020-08-13 |